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## PROPERT Y SUMMAR V SHE)E T Omah aLea dSit e Remedia l Actio nContrac t #EP-S7-10-0 5 Said : 15929 : PrppeftyAddress;271 3 SZOS T 

## Executiv e Summary : •Issue s Encountered : Non e . i 

### 3026138 3

.• , Issue s Resolved : Non e . . 

# IMH I •Uniqu e Finding's : . ^ Superfun d

• .Othe rRelevan t Information : •CONFIRMATIO N SAMPLIN G DATA/RESULTS : B2=31 3 PP M @2" ; Fl = 5 6 PP M @4" ; EA = 8 5 PP M @Scrape ; F2 = 6 3 PP M @4" . 

## Attacliments : Document s Include d i n th e Propert yFile : Ye s N o N/A Propert ysketc h provide d b yEP Apursuan t t o contrac t specification s V Signe d Acces s Agreement ; includin g acces s agreement s obtaine d (i f required ) fo rcrossin g V ont o adjacen t propertie s Pre-excavationagreerTientdetails(i f an yar e mad e wit h th e PropertyOwner ) V Pre-Excavatip n digitia l vide o cli p -V . * ' Samplin g dat a shee t . \ . . \ ^ : . Post-Excavatio n digita l vide o cli p V Documentatio n - Complete d EP Aclose-ou t checklis t V ; As-Buil t sketc h . . V Omah a Lea d Sit e Databas e sampl e informatio n document . V . Signedfor m verifyin g satisfactor yrestoratio n V Othe rDocuments : 3 0 da ySO D warrant ypicture s V Utilit yclearance s documen t V Propert yinformatio n fro m Dougla s Count yAssessor' s office . V Settlenien t document s (i.e . fo ran ydamages ; replacemen t o f plants , etc. ) V Sit e safet yhazar d analysi s documen t wit h pictures . V Legend : Ye s - include d I n th e File ; N o - Not include d i h th e File ; N/ A- Doe s no t Apply . Pruden t Representative : EP AAcceptance : -fj } 

## > N ipi ' .^ ^ 

# y Date : Date : 

# V

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### Pruden t Technologies , Inc . | 250 5 N . 24T H Street , Suit e 30 8 |Omaha , N E6811 0 US A | Tel . 402.504.100 4 | Fax : 402.504.100 5 Environmenta l Engineerin g & Service s | Remediatio n| Constructio n

# 1592 9 Omah a Lea d Sit e Samolin a Address : Z7J 3 S Z O S + 

### Sit e Sketc h Phone : H:*fdi-3<f Z ALT: Sampl e Numbe r RYASCPXA - IS9Z 9 RYBSCPXA - IS92 9 RYCSCPXA - IS92 9 RYDSCPXA-ie% 9 F 1 F2 8 1 8 2 Lea d Concentratio n ^

6 5 pp m ^ / ^ pp m 21 1 pp m •70 2 ppm Sampt e Collecte d 

# i^ RDZSCPX AID9tl 9 

# n nozccPX Ai09£L 9 c z " pp m 

# D RPZSCPXAIG^ 9 p g " " pp m 

# n Numbe ro f Samples = J M Legend : F l = Fron t Lett , F2 = Fron t Right , B l = Bac k Left , B 2 = i LA B 

# D 

# n D D 

# n D 

# n j r \ Exterio rPaint Nort h Arro w • Goo d • Poo r g^No t pain t ^ Samples Collecte d Firm : P E T^C , Jc'A// f X Date : Lj/2q/6f t Time : q- h At ^ Sample s Analyze d XR F Unit : 

### C.gV Q Book : 2m . Oate : _ 

### f g - M • Qf t Time : _ Staff : 

# nsu / Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla y Al l quadrant s ar e a s viewe d fro m th e street , tacin g pir.ip e r>y»..^ ^ 

# .BM T EBEP . JU N 0 2 200 8

META U COM C SVC** * ?0* T WAv u ^ 

# 2T ? 170 2 I v S 

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# PROPERT Y ACCES S FOR M pruden t Technologies , Inc . (Prudent ) is unde r contrac t wit hth e U. S. Environmenta l PFOtectionAgenc y (EPA ) to clea nup lead-contaminate dsoil s at anumbe r ofpropertie s locate d inOmaha , Nebraska , includin g th e propert y locate dat e^Z I \'? s > ^ » aPOtWSr^ . Th e EP A request s you r permissio n to allo w Pruden tto performasoi l cleanu p at thi s property tp remov e lead-contaminate dsoil . By signin g thi s form , th e property owne r grant s permissio n to Pruden tto perfor mactivitie s relate d to th e cleanu p includin g soi l sampling , remova l of lead contaminate dsoil , an drestoratio nofth e reference dproperty . Ifyo u hav e an y question s abou t th e soi l cleanu p planne dfor you r property , pleas e contac t th e Pruden t Offic e fo r th e Omah aLea dSit e cleanu p at (402 ) 733-1188 . General question s abou t th e Omah aLeadSit e cleanu p canbe directe d to th e EP A Publi c Informatio nCenter s at (402 ) 731-304 5 (SouthOmah aoffice ) or (402 ) 991-958 3 (NorthOmah aoffice) . Ifyou r propert y ha s agrave l or dirt driveway s or parkin g area s the nth e removal an dreplacemen t ofth e soi l and/o r grave l durin g th e remediatio nproces s doe s no t mak e you r illegal gravel/dir t driveway s or parkin g area s legal . 

## IBv:/^(^<!>z)/e^ ^

2yy/x.sa> ^ (PleascPri mName ) Property Acces s Grante dI Property Owne r Signature ^ 

# .Z)7a^4nyk J Z)ztliyi' ^ ^oji^|2- o 11 ^—\(Signature) (Date) ) Pfoperty Accesse dby : 

## Ot^i-!:^ - 

# -LWyks. . (Pruden t Employe e Name ) PROPERT YINFORMATIO N (T o be complete d byresiden t and/o rpropert yowne r­ pleas e print ) 1. RESIDENTNAME : VcXC-ay \ W \jr\\ ~ Owne rRente r 2. IF RENTAL , PROPERT YOWNE D BY : VAa.r'u n rv ^

hOoj i ( 3. OWNER' S MAIUN G ADDRESS ; J11\* ^ ^ t-D n KP^l rO KAUJU A ' ^ ^ 4. OWNER' S TELEPHON E NUMBE R - HOME : (Vo2- ) SSS " WORK : ( > 5. TENANT' S TELEPHON E NUMBE R - HOME : ( )- WORK : ( — 1 6. AG E OF HOME?rv.. , YEARS . HO W LON G HAV E YO U LIVE D HERE ? YEARS . 7. HA S TH E EXTERIO R BEE N PAI N R COVERE D WIT H SIDIN G SINC E 1978 ? YE S NO 8. # OF OCCUPANT S UNDE R AG E OF 7: # OFOCCUPANT S AT OR OVE R 7 YEAR S OL D 9. # OF CHILDRE N UNDE R AG E OF 7 WH O PLA YIN TH E YAR D FOifS^OUR S OR MOR E PE R WEE K 10 . COMMENT S OR SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR YGATES , NEIGhBQBIN G PROPERT Y ETC. ) AUTHORIT YFO R ENVIRONMENTA L RESPONS E ACTIONS LTh e acfivitie s tobe implementa d byEP Aunde rthi s agreemen t ar e pursuan t to Sectio n 10 4 of CERCLA , 42 U.S.C . 9604 . EPA' s righ t of acces s to th e propert yis provide d ft> r in Sectio n 104(e ) of CERCLA , 42 U.S . C 9605(e) , whic h provide s entryfb r"determinin g tiie nee d fb r response , orchoosin g ortakin g an yrespons e actio n unde rthi s titie, orotherwis e enforcin g th e provision s of th e titie." 

## Pruden t Technologie s Inc . 5600S. IO** * St . Omaha , NE68107 , 402.733.118 8 (Office) 402.733.188 3 (Fax )ENVIRONMENTAL& CONSTRUCTIO N SERVICE S 

## Propert y Statu s For m Address : ^T\ 3 S ^ 9-OH v S. h' Date : \0\\^ \^ PI ; Phone : , ^ ^ BVID : ) S ^ 2^* ^ 

# Mop. - ^sr3 - <-fS o " 7 NOTIC E T O BE GIVEN/rb : OWNE R ^TENAN TBOT H HO W MUC H NOTIC E I S NEEDED : 2 4 HOURS / 4 8 HOUR S 7 2 HOUR S OTHE R NOTIC E NEEDE D (PLEAS E SPECIFY) : PHON E # AN D NAM E T O WHO M NOTIC E NEED S T O B E GIVEN : WIL L NEIGHBORIN G PROPERTY^E D T O BE USE D FO R ACCESS ? YE S N O I F NEIGHBORIN G PROPERT YWIL L NEE D T O B E ACCESSE D WHA TI S TH E ADDRESS : 

# y y \IA S A N ACCES S FOR M OBTAINE D FRO M TH E NEIGHBOR ? YE S l^O ^ 

## Iw i IL L AFENC E NEE D T O B E TAKE N DOW N T O OBTAI N ACCESS ? YE S 

# ( D

I F ANSWERE D YE S T O NUMBE R 1 2 PLEAS E PROVID E LOCATIO N O F FENCE : I S THER E PRE-EXISTIJs«rfACIA L DAMAG E T O TH E PROPERT YAN D I F S O PLEAS E PROVIDE D LOCATIO N AN D DESCRIPTIO N 

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I S THER E PRE-EXISTIN G C0NCRH;|T3AMAG E T O TH E PROPERT YAN D I F S O PLEAS E PROVIDE D LOCATIO N AN D DESCRIPTIO N O F SUCH : YE S {N O J SPECIFY : 

## Propert y Owne r Pruden t Employe e Q , 

## Signat i 

## ^yr^ ^ yy/(7eti7l^y^MU//y ^ ' ' ^ Signature : . \y^i)dyZ\ W 

# cXkr^li ^ DATE : 7^yy^/^y l Pruden t Technologie s Inc . 560 0 S . lO" * St . Omaha , NE68107 , 402.733.118 8 (Office ) 402.733.188 3 (Fax )ENVIRONMENTA Li CONSTRUCTIO N SERVICE S 

## TECHNOLOGIES , INC . 

## Propert y Inspectio nForm, Address : S'^' T ^ 3 S ;2oH v ^| . Date : lb|l$|2_ol ) Phone : Mr > • ) - SS " g , - L[Sf > 1 

## BVID : IS^l . ^ 

# Pre-Existin g Damage : Pleas e writ e i ndetai l an dinclude dlocatio n an ddescriptio nof damage : Concret e Damage : 

# <^2_t'(-<- \

Vid e '^^'sJ^^ . ^ 

## Facia l Damag e Includin g Siding : 

# |0£ > Doe s Basemen t hav e history of leakin g o r flooding? YE S N O

Doe s Homeowne r wan t so dreplace dinal l areas ? YE S N O IfN O pleas e provid e wha t area s ar e no t t o b e sodde dan dwha t need s to b e replace dinstea do f

so d(i.e . mulch , rock , leav e bare ) if mulc ho r roc k pleas e specif y wha t typ e an dcolor ; 

# QaA . o M o^Lju xrp i ,v=2_ ^ B2_ . "J AN Y OTHE RDAMAGEO RREQUESTS : 

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## Propert y Owne r Pruden t Employ ^ Signatur e 

# :y7k:i^J^i^! ^ y^-^^-^* ^ " Signature : DATE ; /^ , 

## ^fy/y y DATE :C0NS3EReCTliQ S 

### TECHNOLOGIES i INC . SERVICE S 

# XB I CLEARANC E SHEE T PROPERTYADDRESS : SCl . iS^'^C^ ^ PROPERTY ID : I S^^ ^ MA PHA S BEE NREVIEWE D AN D N O MISSE D AREA S EXIST : ^YE J N O WA S CONTAMINATIO NLEF T BEHIND ? I FYE S WHER EAWDIMENSIONS : M 0



# CREW : Y\l,^r^ ^ . DAT E DEPT H QUADRAINT 

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### PI.AYZON E EASEMEN T 

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•TECHNOLOGIES , INC . 

# •EP A Property , Cl<>s0 ^ Out'; ; ;.-.^ ' Propertj'#:A6^.2< H Pate/Tinie- : ' , ;••" : y PropertyAddress : ^^V ^ 5^?< ? Owrier's'Nainer/Kar.v^v.^^VvA'L^ St ­ • • . • • Quad s Excayatbri : ,p | 12: , S '^ ' Contracto r Groiip : Priiden t Technologiies , Inc. , Excavatio nGeneral . • Ye s N o ,L - I f iiecessary , wer e th e correct quadraiTt(s) excavatedandrestored? ' . ' / 2 .

I f necessary , wer e th e correct area s o f drip zone excavatedandrestored ? / Gradin g Sodan dVegetatio n Ye s N o 1 .

Doe s th e grading aroundth e perimete r o

f th e hous e inexcavatedarea s generall y slop e away . fro mtli e house ? / 2 .

Ha s sodbee nlai di nall area s tha t wer e excavated ? / 3.. , Doe s th e sodappea r to b e generally health y andgrowing ? (Onl y evaluate ifinspecte da t a3 0 da

y tim e period) y 4. .Ar e sodde darea s generall y firmaii devenl y graded ? , : . , 

# y 5 . . Ar e di e joint s betweentli e sodstrip s geiieraiiy tight?.(Only evaluatei f inspecteda^ •- • • '. • time.period) • ' .••••' '. . •' . V • •'. • •' • •••-•.'.•.:'•.'.•' ­ • • > • •' . 

### 6 .Was di e piopert y gradedsuc h tiiat wate r wil l no t pool o nth e property ? 

# 'y . .7. . Was darnag e t o landscaping o r plan t material s avoided ? 

# y Gates , Fence s an dRetainin g Wall s Ye s N o

. 1. . Do , gates , ope nan dclos e freely ? (Ifapplicable ) . , 

# y 2 .Wer e ai l gate s o r fence s takendow nduring restoratio nactivitie s reinstalled ? (I f applicable ) 

## • y . .3 . Was damage.lo.gate s o r ferice s avoided ? (I f apjiiicable). . 

# y ...4. " Was dainag e t o retainin g wall s ayoided ? (Ifapplicable ) • . . 

# y Fouiidation , Sidiiig.an dGlitter s . . Ye s No- . 1 .

"Wa s damag e to th e siding o r tiii navoided? . • . • 

# / y 2 .Was daiiiaget o th e foundationavoided?- . 

### • y 3 .

Was damag e t o window s avoided ? 

# 7 4 .

Was damag e t o wiiidow s o r doo r screen s avoided ? 

# 7 5 .

Was dajnag e to downspout s o r downspou t e.xteiisipns avoided ? / Sidewalk.* ! an dDriveway s (Concrete )Ye s / N o 1 . . Was dajnag e l o diivewa y surface s avoided ? / 2 . Was damag e to walkwa y surface s avoided ? /

## • .Owner i 'cohiimeiiits :

.Inspectiojo . .notes :

Remova J andrestoratio nactivate s compJet e incJudin g tJie 30-da y so dwarranty ; EP A Representativ e g*^, H ^Daie:

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# mj i TECHKOLOCiES . INC . Sampl e Area : 15V2 9 - 271 3 S Z O S t Dat e Excavated : 11/03/201 1 Sample dBy : Ljohnso n

tlYA.'iCPXA - 1592 9 RYBSCPXA - (S92' > RYCSCPXA - IS9Z 9 HYDSCPXA)S% 9 BOaSCPXA . toOa' ? F l f 2 B l 6 2 O Z -B«6fePX A109£ » Gi ? JIPXSCPX Aftj'gg? f'^ - 

### A S - BUIL T DRAWIN G OMAH A LEA D SUPERFUN D SIT E CONTRAC T # : EP-S7-10-0 5

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Pruden t Technologies . In c | 250 5 N . 24TH Street . Suit e 30 8 jOmaba , N E6811 0 US A | Tel . 402.504.1004 1 Fax : 402304.100 5 Environmenta l Engineerin g & Service s | Remediatio n| Constructio n

# • • 

# r Fin d Recor d ..<emedKi<io n Quer y Lea d Remainin g Quer y Propert yDainag e Quer y O K Propert y M b Oean-u p Inf o liJ^fM^..i||'[^J i Custome rCali s Sidewai k itepai r Sampr e Area : 1592 9 - 271 3 S 20 ST I Sampl e Dat e „ Quadran t^i Paramet e - XR F Re . XR F Re s Ex c- Marke rPlac e -. Lea d Remaini n - In * » Sampie d B. QAConfirme e - Lab_R e ' 11/3/201 1 B2 LEA D 31 3 mg/k g 2 Ljohnso n N/ A 11/3/201 1 E1 LEA D 85 mg/k g 1 ; _ Ljohnso n N/ A [ 1 11/3/201 1 F l " LEA D 56 mg/k g 4 

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### , Tfiis ^ agreepent.db6Hiiiieritsi.t^^^^^ c6mpleiion;pf : Femovai : aptivitie s .peifprrae do ntb e befow ; liste dpcopeity ; ; Tide ; pFpp.e"iii y ;awHfii;' s -signaiui;^ ^ progeni]^ ; awfier ii

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### • YOU R TICKE T NUlllBE R I S 2892027 . Origina l Cal l Date : 11/01/1 1 Time : 3:4 5 p m Op : ASHLEIGH1896 7 Wor k t o Begi n Date : 11/03/1 1 Time : 4:0 0 p m State : N E County: DOUGLA S Place : OMAH A Address : 271 3 Street : S 20T H S T Twp : 15 NRng : 13 E Sect-Qtr : 27-SW,34-N W Twp : Rng:. - .. • Sect-Qtr : '•'*.-, , Lega l Given : C Typ e o f Work : LEA D SOI L REMEDIATIO NPROJEC T Locatio n o f Work : ENTIR E PROPERT Y Remarks : FA X AL L CLEAR S TO : (402)733-188 3 : UNSUR E CORNER S Compan y: PRUDEN T TECHNOLOGIE S Contac t Name : ASHLEIG H ANIKPUT A Phone : (402)733-118 8 Alt . Contact : NON E Wor k Bein a Don e For : EP A

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# 7 1 77 3 S . y/ ^ Dat e /C>y?'^7 / Analysi s Complete dBy _ 

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